A recent study has revealed a two-way relationship between diabetes complications, such as heart attacks and strokes, and mental health conditions, including anxiety and depression. The study found that people with diabetes-related complications have a higher risk of developing mental health issues, and those with mental health disorders are more likely to experience complications related to diabetes. Researchers suggest that this bidirectional link may not be entirely direct, as both diabetes complications and mental health conditions share common risk factors like obesity and poor blood sugar control, which increase the likelihood of developing both types of disorders.
Maya Watanabe, a biostatistician at Harvard University's School of Public Health and the study’s lead author explained, "Most likely, a combination of direct and indirect effects, along with shared risk factors, drive the association we are seeing." She emphasised that diabetes care providers might reduce the risk of multiple complications by addressing these shared risk factors.
The study, published in the journal Diabetes Care, analysed insurance claims data from over 500,000 individuals with type 1 or type 2 diabetes and more than 350,000 people without diabetes, spanning from 2001 to 2018. The findings indicated that people with a chronic diabetes complication had a two- to three-fold higher risk of developing a mental health condition. However, those with mental health disorders were up to 2.5 times more likely to suffer from sustained diabetes complications.
"We found a consistent bidirectional association between chronic diabetes complications and mental health disorders across the lifespan, highlighting the significant relationship between these conditions," the study authors said. They also suggested that the prevention and treatment of one condition could potentially reduce the risk of developing the other.
The study found age-related differences in the prevalence of these conditions. Among people under 60, those with type 1 diabetes were more prone to chronic diabetes complications, while those with type 2 diabetes were more likely to suffer from mental health disorders.
The researchers proposed several reasons for this bidirectional relationship. One possibility is that having a diabetes complication directly increases the risk of developing a mental health condition. For example, a stroke can have severe effects on the brain, potentially leading directly to depression. Having a mental health condition while managing diabetes can negatively affect self-care behaviours, such as maintaining good glycemic control or adhering to medication regimens, thereby increasing the risk of diabetes complications.
Senior author Brian Callaghan, a professor of neurology at the University of Michigan, explained, "For instance, a stroke causes detrimental effects on the brain, which may directly lead to depression. And having a mental health condition and diabetes may affect a person's self-management of their condition—like poor glycemic control or not taking medications—which, in turn, may increase their risk of diabetes complications."